MEDICARE: PASQUALE J. MALPESO DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		NY
2	1223P0300X	Periodontics		NY

General Provider Information

NPI Number	:	1407002264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASQUALE J. MALPESO DMD PC

Provider Business Mailing Address
First Line	:	563 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7314
Country	:	US
Telephone Number	:	212-838-0090
Fax Number	:	212-935-1296

Provider Business Practice Location Address
First Line	:	563 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7314
Country	:	US
Telephone Number	:	212-838-0090
Fax Number	:	212-935-1296

Authorized Official
Title or Position	:	MEDICAL BILLER
Name	:	MRS. JEANETTE DIAZ
Credential	:
Telephone Number	:	212-838-0090

Provider Enumeration Date	:	08/13/2008
Last Update Date	:	05/03/2017

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